My Decision

So what happened this week? Oh so many things...but the biggest thing that has happened is that I've decided until further notice that I will not be getting a prophylactic double mastectomy and resulting breast reconstruction. I will have my lumpectomy and radiation and then my reduction and lift.

I have two issues - The first is I still have to learn whether or not I can have the reduction at the same time as the lumpectomy or is it better to wait until after radiation (which shrinks the tissue and complicates healing; and if I do it at the same time Dr. McAndrew has said I will most likely require a slight revision at some point). The second is if I don't get clear margins after the lumpectomy then I will have to have a mastectomy regardless anyway and the whole decision process will be moot.  

There is so much detail into how and why I've made this initial decision which I will divulge at another time but in a nutshell, the way I, the novice, am looking at it is:
1) I am not a gene carrier;
2) I feel it was a fluke of infertility drugs that caused my cancer (perhaps I had some predisposition, albeit not genetic, towards cancer and the pregnancies and fertility drugs just amplified it into overdrive and catapulted the cancer to grow so aggressively. The timing fits according to the doctors I've seen, they feel my tumor has been growing for at least 3 years, I had my first miscarriage in 2007 then in 2008 did the fertility drugs to stimulate 13 follicles and grow 11 embryos that then resulted in the twins, then a break while breastfeeding Abby, then the pregnancy with Leo);
3) Double mastectomy will not completely eradicate the chance that the disease will return (it is 90% effective but it is impossible for a surgeon to remove all breast tissue;
4) I will be closely monitored to detect recurrence and a double mastectomy won't change that;
5) I will be taking tamoxifen for 5 years to prevent recurrence;
6) Because I naturally have large breasts it complicates my reconstruction. Dr. Orringer said that the process will be more intense and more difficult.  Breast reconstruction is a very involved process; there is the mastectomy first, the reconstruction is started at the same time for best results which means expanders are placed under the skin to stretch out the skin and tissue (that can take 3-6 months), then you have to have another surgery to get implants, then you have to go back again to create nipples and areolas, then you made need adjustments, then you may need to replace the implants as scar tissue builds up around the implants (and this is especially true for radiated tissue), and then, and then, and then...NO, and then!!!  (That's a reference to Dude, where's my car FYI...)

Anyway, that's kind of where I'm at for the moment.  I still have a million, zillion questions that I will ask Dr. Guiliano and Dr. McAndrew and the rest of the plastic surgeons that I am meeting with in the coming weeks.  But that's my two cents.